Travel health

Question 1

Fever in returned traveller: Hx

Answer 1

Any pt with fever ask: ‘Have you travelled anywhere in past 12 months’
• location/itinerary/dates
• exposures: sex, insect bites, animals, fresh water, foods (raw), needles/tattoos
• PPE used
• pre travel vaccine/malaria prophylaxis
• sick contacts

Question 2

Fever in returned traveller: Ddx

Answer 2

In decreasing order of frequency:
•	Malaria!!
•	Resp illness incl inflenza
•	GI illness
•	idiopathic
•	Dengue fever
•	Chikungunya
•	Enteric fever
•	Rickettsial fever
*Don’t forget can also be non travel related cause of fever

Question 3

Fever in returned traveller: Initial Ix

Answer 3

• septic screen: FBE, CRP, urine, CXR, blood cultures
• malaria thick and thin films & rapid test x 3 at 12 & 24hr intervals
• Dengue & Chikungunya serology
• Rikettsial serology
• Stool MCS/PCR test

Question 4

Schistosomiasis

Answer 4

Acute infection 2-6weeks post exposure:
o fever
o abdo pain
o cough: lasts 6 weeks
o headache
o myalgia
o urticarial rash
Ix:
Hard to dx acute infection- need to exclude other things
• FBE: eosinophilia (sometimes)
• Stool/urine micro: Ova production not till 30-50 days post exposure
• Serum serology: may take up to 3-6 month post exposure to become positive, stays positive for a long time (can’t check proof of cure)
Mx
o Acute: managed by ID physician- refer, praziquantel may make Sx worse
o Chronic (>3/12): Praziquantel (needs to have matured to adult worm)
o If swam should have serological testing 3/12 post even if asymptomatic

Question 5

Influenza: who to screen and treat

Answer 5

When to Ix:
• NPA viral swab for culture: only if definitive dx would change Mx (i.e. high risk pt/contact)

When to treat:
o <48 hours of onset of influenza-like illness and with likely exposure AND
o at high risk of complications from influenza. Those at high risk include:
• >65 years of age, children <5yrs (espc <2yrs!)
• pregnant
• have chronic illnesses incl obesity
• younger than 10 years old and are receiving long-term aspirin therapy
• ATSI >15
• residents of nursing homes

Mx
• Neuraminidase inhibitors (NAIs): oseltamivir (Tamiflu) and zanamivir (Relenza) –> influenza A&B

Question 6

Malaria chemoprophylaxis

Answer 6

• doxycycline 100 mg once daily, starting 1 day before entering and continuing for 4 weeks after leaving
• atovaquone 250 mg/proguanil 100 mg tablets (malarone), starting 1-2 days before and continuing for 7 days after
• Mefloquine: 250mg weekly. Start 2-3 weeks before, continue for 4 weeks post
o Start early incase SE and need to change
o Neuopsych SE: mood, nightmares, depression 5-10%

Question 7

Japanese Encephalitis

Answer 7

• Risks for exposure: long stay >1/12, mosquito exposure dusk-dawn, outdoor activities (aid workers, missionaries, hikers etc)

Vaccine
o	JEspect (inactive): 2 doses, 28days apart, booster 1-2years after
o	Imojev (monovalent live attenuated): single dose, can consider booster in 5 yrs, booster for children  <18 1-2yrs after initial vaccine

Question 8

Gonorrhoea: Dx/Mx

Answer 8

In symptomatic individuals need to take swabs for culture/Abx sensitivity before treatment (Abx resistance possible)

o ceftriazone 500mg IM diluted in 2ml of 1% lignocaine
o Azithromycin 1g oral stat dose
o avoid sex until review of appropriateness of treatment
o Contact tracing
o Notify health dept
o Retest after 1 month